Ray's Take

Exercise is the most powerful drug.

Yes. It's true. You've probably heard this before, but it's worth gaining knowledge of the actual evidence. I'm sure it'll make you motivated to start an exercise program, or stepping up your existing program.

VO2 max

To analyze, we are referring to a massive study of 122,007 people with average age of 53. Follow-up was average 8.4 years.

We all know smoking is bad, really bad. If you smoke, you were 41% more likely to die.
None of us want diabetes. If you had diabetes, you were 40% more likely to die.
None of us want heart disease. If you had heart disease, you were 29% more likely to die.
None of us want kidney disease. If you had end stage kidney disease, you were 2.78 times more likely to die.

Here's the evidence.
If you had low VO2 max, you were 3.9x more likely to die than if you had high VO2 max. That's crazy.

Just taking low VO2 max (bottom 25%) to medium levels (25-75%) you cut your risk of dying by ~2-3x. This is WAY MORE powerful than quitting smoking, or not having heart disease!

The higher your VO2 max, the less likely you are to die

This graph shows "there is no upper limit" to the benefit of improving your cardiovascular fitness (VO2 max). Survival probability on the Y-axis means how likely you were going to not die, over time which is on the X-axis. You want the graph to stay as close to 1.0 aka 100% as possible.

As you can see, there is a massive difference in survival (not die) rate going from low to below average. It's very cool that there is even a benefit going from high to elite. This means:
- Every single person should improve their VO2 max, with no "upper limit" of benefit for living longer
- If you are in the low category range (don't exercise), it is particularly important for you to start exercising

If you want to know where you land, here are the cutoffs for VO2 max:

If you have an Apple Watch, it gives you an approximation, though there are more accurate ways to measure.

Strength

To analyze, we are using a large study of 4449 people who were 50 or older, average age of 53. Follow-up ~10 years.

If you had low muscle strength (LMS), you were 2.34x more likely to die.
If you had low muscle mass (LMM), you were 1.47x more likely to die.
*Don't worry about ALM - that means appendicular lean mass aka muscles on your arms and legs
**1.47 comes from ALM/BMI meaning muscle mass per total body mass. ALM

Interesting points here:
- Strength is more important than muscle mass
- If you are strong, but have less muscle, its ok.
-If you have a lot of muscle but a lot of body weight, its actually not protective.
- If you are strong, you probably have more muscle too.

Stupid ideas

I already have high strength and muscle mass so I'm good
Without training, strength declines at least 1% per year. Probably closer to 2% and up to 4%. The compounding effect of this is crazy. 10 years at 2% loss per year and you'll be left with 81.7% of your strength. A massive decline.

I am already pretty fit and my Apple Watch says my VO2 max is above average so I'm good
VO2 max declines 10% per decade. You have to train to reduce this loss with age.

What I would do

Start or step up your strength and VO2 max program, immediately.